Freestyle aortic root bioprosthesis is a suitable alternative for aortic root replacement in elderly patients: a...

Area of Science:

• Cardiovascular Surgery
• Bioprosthetics
• Geriatric Cardiology

Background:

• Aortic root replacement is a critical procedure for elderly patients.
• Comparing bioprosthetic valves with mechanical valves is essential for optimizing outcomes.
• The Freestyle stentless bioprosthesis (FSB) offers a potential alternative to mechanical valve conduits.

Purpose of the Study:

• To compare early and midterm clinical outcomes of aortic root replacement in elderly patients.
• To evaluate the safety and efficacy of the Freestyle stentless bioprosthesis (FSB) versus mechanical valve conduits.
• To assess long-term freedom from major adverse valve-related and cardiovascular events (MAVCE).

Main Methods:

• Retrospective study of 185 patients undergoing aortic root replacement (2001-2010).
• Group F: 79 patients received FSB; Group M: 106 patients received mechanical valve conduit.
• Propensity score analysis adjusted for preoperative and operative characteristics; endpoints included 30-day mortality, 5-year survival, and MAVCE.

Main Results:

• Thirty-day mortality was comparable between the FSB and mechanical valve groups (2.5% vs 5.7%).
• Adjusted analysis revealed significantly higher 5-year freedom from cardiac death and MAVCE in the FSB group (98.6% vs 88.0% and 97.4% vs 81.2%, respectively).
• Multivariate analysis confirmed a significantly lower risk of 5-year MAVCE with FSB implantation (HR, 6.87; p=0.016).

Conclusions:

• The Freestyle stentless bioprosthesis (FSB) is as safe as mechanical composite grafts in the perioperative period for elderly patients.
• FSB implantation leads to superior midterm freedom from major adverse valve-related and cardiovascular events (MAVCE) compared to mechanical valves.
• FSB represents a favorable option for aortic root replacement in elderly patients, offering improved long-term valve-related outcomes.